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Amputation of extremities. Definition Cutting of the extremity or part of the extremity through the bone Cutting of the extremity or part of the extremity.

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Presentation on theme: "Amputation of extremities. Definition Cutting of the extremity or part of the extremity through the bone Cutting of the extremity or part of the extremity."— Presentation transcript:

1 Amputation of extremities

2 Definition Cutting of the extremity or part of the extremity through the bone Cutting of the extremity or part of the extremity through the bone While ……….. Cutting of the extremity extremity or part of the extremity through the joint is disarticulation Cutting of the extremity extremity or part of the extremity through the joint is disarticulation

3 indications indications Amputation can be regarded as a treatment and not tragedy Amputation can be regarded as a treatment and not tragedy indications :- indications :- 1. Dead ( or dying ) limb 2. Dangerous limb 3. Damn nuisance limb

4 Dead or dying limb 1. Peripheral vascular disease ( 90% ) 2. Sever traumatized limb 3. Burns 4. Frostbite

5 Dangerous limb 1. Malignant tumors 2. Lethal sepsis 3. Crush injury leading to crush syndrome

6 Damn nuisance Remaining the limb is more worse than having no limb at all …. Because of :- 1. Pain 2. Gross malformation 3. Recurrent sepsis 4. Sever loss of function

7 Varieties of amputations Provisional amputation When primary healing is unlikely When primary healing is unlikely The limb amputate as distal as the causal factor will allow The limb amputate as distal as the causal factor will allow Skin flap suture loosely over a pack Skin flap suture loosely over a pack Re-amputation perform when stump condition is favorable Re-amputation perform when stump condition is favorable

8 Definitive end-bearing When weight is taken through the end of the stump When weight is taken through the end of the stump The scar must not be terminal The scar must not be terminal Bone end must be solid (cut near the joint) Bone end must be solid (cut near the joint) Example through knee, syme’s Example through knee, syme’s

9 Definitive non-end-bearing Commonest variety Commonest variety All upper limb & most lower limb amputations are come under this type All upper limb & most lower limb amputations are come under this type The scar can be terminal The scar can be terminal

10 Amputations at the sites of election Amputations at the sites of election

11 The “ sites of election ” are determined by :- The “ sites of election ” are determined by :- 1. the demand of the prosthetic design 2. local function e.g bellow the most distal palpable arterial pulsation

12 Too short a stump  slips out from the prosthesis Too long a stump  painful, ulcerate, complicates the incorporation of the joint in the prosthesis Now a day the skill of orthotiest make amputation possible at any level

13 Principles of technique Principles of technique

14 Tourniquet is used unless there is vascular insufficiency Tourniquet is used unless there is vascular insufficiency

15 Skin flaps are cut so that there combined length equals one & half the width of the limb at the site of the amputation Skin flaps are cut so that there combined length equals one & half the width of the limb at the site of the amputation Equal flaps are for upper limb & trans- femoral amputations, long posterior flap for bellow – knee Equal flaps are for upper limb & trans- femoral amputations, long posterior flap for bellow – knee

16 Muscle cut at distal level from the level of the bone proposed Muscle cut at distal level from the level of the bone proposed Myoplasty …. When the muscles sutured together over the bone Myoplasty …. When the muscles sutured together over the bone

17 A raw nerve end should not bear weight A raw nerve end should not bear weight Divide the nerve proximal to the bone cut Divide the nerve proximal to the bone cut

18 Saw is used to make the bone ends smooth, and for beveling the tibia interiorly Saw is used to make the bone ends smooth, and for beveling the tibia interiorly Fibula is cut 3 cm shorter Fibula is cut 3 cm shorter

19 Remove the tourniquet and stop bleeding Remove the tourniquet and stop bleeding Suture the skin without tension Suture the skin without tension Apply suction drain Apply suction drain Bandage the stump tightly Bandage the stump tightly

20 Aftercare Evacuate the hematoma as soon Evacuate the hematoma as soon Elastic bandaging the stump for shrinkage Elastic bandaging the stump for shrinkage Exercise the muscles Exercise the muscles Keep joints mobile Keep joints mobile Advice using the prosthesis Advice using the prosthesis

21 Amputations other than the sites of election

22 upper limb amputations upper limb amputations Interscapulo - thoracic amputation which is known as fore-quarter amputation Interscapulo - thoracic amputation which is known as fore-quarter amputation Disarticulation of the shoulder Disarticulation of the shoulder Transradial amputation Transradial amputation Amputations in the hand Amputations in the hand

23 Lower limb amputations Hemipelvectomy Hemipelvectomy Disarticulation through the hip joint Disarticulation through the hip joint Transfemoral ( at least 12 cm ) Transfemoral ( at least 12 cm ) Around the knee ( Stokes – Gritti ) Around the knee ( Stokes – Gritti ) Through knee Through knee Transtibial ( 14 cm ) Transtibial ( 14 cm ) Above the ankle ( Syme’s ) Above the ankle ( Syme’s ) Boyd’s amputation in which there is calcaneo tibial fusion. Boyd’s amputation in which there is calcaneo tibial fusion. Mid-tarsal joint ( chopart ) Mid-tarsal joint ( chopart ) Tarsometatarsal joint ( lisfranc ) Tarsometatarsal joint ( lisfranc ) Ray excision of entire toe. Ray excision of entire toe.

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32 Complications of the amputation stump

33 Stump is the terminal segment of the limb remaining after the amputation Stump is the terminal segment of the limb remaining after the amputation

34 Early complications 1. Secondary hemorrhage 2. Breakdown of the skin flaps (may be due to ischemia or excessive suture tension ) 3. Gas gangrene

35 Late complications Skin eczema eczema purulent lumps purulent lumps fissuring & ulceration fissuring & ulceration infected epidermoid cyst infected epidermoid cyst Squamouse cell carcinoma Squamouse cell carcinoma Verrucous hyperplasia Verrucous hyperplasia

36 M uscle.. If excessive muscle left, it will produce unstable, loose cushion M uscle.. If excessive muscle left, it will produce unstable, loose cushion

37 Artery … poor vascularity gives cold cold blue color stump blue color stump liable to ulcerate liable to ulcerate

38 Nerve. Painful neuromas attached to the scar Painful neuromas attached to the scar

39 Phantom limb A feeling that the amputated limb still present A feeling that the amputated limb still present It is difficult to be treated It is difficult to be treated

40 . Joint the joint above the site of amputation may become stiff or deformed the joint above the site of amputation may become stiff or deformed Deformities are fixed flexion & fixed abduction in above knee ….. Fixed flexion in bellow knee amputations. Deformities are fixed flexion & fixed abduction in above knee ….. Fixed flexion in bellow knee amputations. Fore-foot amputation maybe cpmplicated by equineus deformity. Fore-foot amputation maybe cpmplicated by equineus deformity.

41 Bones terminal bone spur may cause pain & infection terminal bone spur may cause pain & infection Stump bone fracture may result from sever osteoporosis Stump bone fracture may result from sever osteoporosis

42 prosthesis

43 Ideal prosthesis 1. Fits comfortably 2. Function well 3. Looks presentable 4. Fit as soon after the operation

44 In the upper limb the distal portion is detachable & can be replaced In the upper limb the distal portion is detachable & can be replaced In lower limb weight can be transmitted through the greater trochanter, tibial tuberocity, patellar tendon, upper tibia or soft tissues In lower limb weight can be transmitted through the greater trochanter, tibial tuberocity, patellar tendon, upper tibia or soft tissues Electrically powered limb is present now Electrically powered limb is present now

45 Some real photos of amputation

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51 thanks


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